“Medical Practice Business Transformation—Concierge
Practice”

(Part 2 of 2)It is
predicted that private practice will
disappear
by 2013-2015. What are your
options?

(Find out if it comes into your
crosshairs, doctor.)

(Part 1 of this
article revealed the promising attributes to patients
and physicians of concierge medical practice and the
rising benefits, needs, and reasons for physicians to
consider that method of practice.)

Hybrid Model Concierge Medical Practice

With respect to the
sensibilities of your patients, the hybrid model
doesn’t disenfranchise your patients or contribute to
physician shortage, contrary to the propagated image
of “cash only” medical practice.

The commonly used
transition method is to recruit from 10 to 20 of your
patients who elect to join the concierge practice
model for an annual fee. Other patients who are not
interested, continue with their primary care physician
as usual. The downside for physicians is that they
have to juggle between patient categories among a
continuing large number of regular
medical patients.

It’s reasonable to
assume that by the time the patients who have not
joined the concierge group become so disturbed about
the increasing co-pays, 8 minute office visits, longer
waiting periods to be seen, that they will see the
benefits of joining the concierge model willingly. The
old “capitation model” of practice in the 1980’s was
similar but never really caught on.

Once a physician is
comfortable with the model, understands the value of
such a model to himself, his practice time, and his
lifestyle improvement, recognizes that by converting
his practice completely over to the concierge model,
will he have to see and care for less than 500
patients to earn the same amount of money he earned
before with 3000 patients.

But, also will assuredly
provide better medical care because of having time to
read more journals, go to more medical education
meetings, able to take more time to increase his
skills and training, and, most of all, have more time
with his family. Can you imagine that?

Innovation Model Concierge Medical Practice

Without a doubt,
beginning your new medical practice using the
concierge model avoids having to accumulate a large
herd of patients and then converting to a “direct
primary care practice” later on. The big disadvantage
is that the startup of medical practice requires
money, usually a
fairly
good bundle.

Just picture the
lender’s face when you explain to him that you have no
job and that you have a left-over debt of $150,000
from your education---and are asking for another
$50,000 to get started on top of the
other debt. Thank God you have a rich uncle to help
you financially.

Of course, you’ll
have that same problem with the bank no matter how you
begin your practice. You could join an HMO, gather
the money up, then
start your private practice. Maybe
there’s a group practice you can join first already
employing a “retainer-based” method of practice, and
go from there.

Transformational Model
Concierge Medical Practice

So, you’ve been in
practice 15 years already. It must be disturbing for
you
to see the decrease in income earned by physicians
(8% decrease average over the past 10 years according
to the AMA studies, among others). Then you wise-up
and ask yourself if you know for sure whether
your practice is growing… you know, the number of
patients joining minus the number leaving monthly.
Or, haven’t you done that? Or… maybe start now?

Most physicians see
what’s happening now in the world of medical
practice—and it ain’t good. Choices for medical
practice careers haven’t changed, really. But, the
consequences of those choices now are very different,
and are important to know about for medical practice
business reasons.

Transforming you
practice is not easy. Some follow the hybrid model to
transition and some flat set a date to stop your
regular practice and begin your concierge practice.
We’ll talk about the issues related to that
move in
another.

Private Practice Group Model

Luckily, there are a
good number of medical group practices who have come
together in a concierge practice in this country which
you might choose to join. In addition, with the
gradual dissatisfaction with the health care system
and the gradual increase in numbers of patients
looking for alternatives, the concierge practitioners,
already solo or in a group, will be looking for
physicians of a like mind to join them.

Practice
overhead will be reduced by adding a new doctor to the
staff. Retiring physicians leave openings for new
physicians. When you join such a group, it is very common
to be obligated to pay additional
amounts to the owners of the
building... often to one or two of the
other doctors.

Solo primary
practice physicians in private practice, especially in
rural areas, are disappearing. But if they join
together in group practice, this attrition would be
far
less common.

Commercial Model Concierge Medical Practice

Concierge Choice
Physicians (CCP), a medical practice consulting
company, is one of the several groups who offer a
turnkey solution to physicians who sign up for their
assistance and joint venture. This company splits the
annual patient concierge subscription fee with the
doctor and also provides all the marketing services
paid for by the subscription fee arrangement. CCP has
special interest in working with
the Hybrid Model.

Other physicians
have created joint ventures with large businesses
which refer large numbers of their employee patients
to the concierge physician practice in return for
providing office space, equipment, supplies, and other
necessities. The employees pay the annual
subscription fee to the doctor and the company has
saved thousands of dollars spent on large health
insurance plans which are much more costly and
administratively complex.

Be creative and
create your own special joint ventures.

I know! ... I’m
getting
to
that next.

The
where and how elements of concierge medical practice

The most common
reason that a concierge practice fails is lack of
income. The lack of income to sustain the practice
comes when a concierge practice is not able to recruit
enough patients. Success requires about 300 patients,
per physician, enrolled, at least. As with any
regular medical practice, you don’t make money or earn
an income without patients. But, you
already know
this.

The topic brings us
back to what is critically important and what most
physicians neglect before starting a medical
practice—Demographics.

Considerations to face head-on if you want a
successful concierge practice...

Big enough population to attract
enough patients-- I haven’t seen any studies
concerning this issue, but, my belief is that you
should have no serious problem launching a practice in
any urban area of one million populations... where you
will be the only concierge physician for that
population.

This criteria has to be modified by the
affluence of the area, local industries and
businesses, availability of educational and
recreational facilities, and the average income of the
population, among others.

Because of the scarcity in the
present
day (2010)
of numbers
of
concierge
physicians,
the
competition
for
patients
should not
be an
issue in
this
population
for the
next
decade.

Professional Competition--
Contacting various resources available
on the Internet
which provide such information is easy to find. For
example, in February 2010 an informal one year summary
of
findings related to the concierge medicine
marketplace
was released.

Over 66% of current U.S. concierge
physicians in
practice are internal medicine
specialists.

Second in rank are family physicians.

Since early 2009, there has been a steep
rise in
numbers of concierge dental and pediatric
practices—understandable, because they are
primarily
office based practices with large
volumes of patients.

One shouldn’t leave out the increasing numbers of
plastic surgeons
using this same game plan. As the
antagonism between physicians and government
interference in health care increases, the high
probability
of physicians opting out of commercial
health insurance programs and government Medicare and
Medicaid will happen.

It’s reported now that over 30% of
physicians have already stopped seeing
Medicare/Medicaid patients.

Affluence counts-- Go where the
money is! At least you should
practice very close to
those areas of your city. Patients with money
are the
ones you most likely want to cater to in your practice.
Whether you admit
it or not, you do cater to them as well. By
marketing
your concierge practice to the affluent, you will build
your practice more rapidly than otherwise.

The affluent seek special
attention, best quality of medical care, convenience
of services,
and are willing to pay for it. Any
patient
or family with an income over $200,000 will be
looking for a
concierge medical practice, and often
don’t know it, don’t know
how to find one, or where to look.You have to tell them.

What you must understand about business and
practice success at it’s best

You are in control of your life and
professional career.
All those who criticize you for
being an elitist, a
violator of your medical oath, or
leaving the poor
people to be treated by someone else
don’t give a
damn about you or whether you succeed or
fail.

You can’t do anything without money.
You have every
right as a professional to attract and
grow your
income
to the level you need, and no one
objects
to that as
long as it is done ethically and
professionally.

You never signed a contract to be poor,
to treat all
the underprivileged, to sacrifice your
children’s education,
to give up on your lifestyle
dreams, to go without just
for the sake of what some
call social justice. It doesn’t mean you shouldn’t
treat such patients, as
we all have done one time or
another, but, it does
mean you don’t have to feel
obligated to destroy
your practice and life by doing
so. It’s what some
mentally handicapped people
who support social
justice imply.

Your medical practice income comes from
providing
good healthcare to all your patients, no
matter how
you derive that good income within
professional bounds. The wealthiest doctors that I
know are the greatest
contributors to charity
organizations and organizations
that support health
care.
If it were all said and done, I believe that
their
contributions during their life in medical
practice leads
to more healthcare for the poor around
the world than
all the years in medical practice that
one might do
catering to poor patients. You can’t do
that when
your
medical practice can barely support
itself.

You don’t have to be liked—just
respected.

Self-esteem counts--
You can’t go
into a concierge practice feeling
guilty. You were
taught how to be a good doctor. No one dictates
who
you treat, at least not as of today. One of the
greatest gifts
a physician has are the God given
talents and skills to
practice
medicine freely.

My
view of the future of concierge
medical practice

The middle class of
our society is slowly being squeezed out by the
economics of our country, the lack of a work ethic,
entitlements, and the descent from holy ground.
Division of our society into the poor and rich
not
only is inevitable, but also creates a divided mindset
about medical practice
as a profession.

I expect the
medical profession will become more fragmented in
terms of
sub-sub-sub-specialties clearing the road for
all midlevel providers to take over the
majority of healthcare. In essence, the opportunities
for physicians to remain in direct contact with
patients to any significant degree will be fulfilled
by concierge medical practice.

Back in my middle
years of OB-Gyn practice at the beginning of the
managed care tsunami (1970’s) as a means of reducing
medical care costs was the first time I ever heard of
a “cash only” medical practice. I never thought any
physician in their right mind would have the
guts to
try it.

But, changes, influenced by circumstances,
continue to lead us around to places we don’t choose.
Concierge medical practice may very well be a good
place to be in the future. If I had the chance to
start medical practice over again in my 20’s, I would
go the concierge route for many reasons. And… care
a hell of a lot less about what our government chooses
to do with
control of healthcare.

It seems obvious
that most physicians know very little about concierge
medicine other than through short articles about it in
medical journals.
Most patients know nothing
about concierge medical care, except those
in the
inner circle of healthcare.

A smart physician who is
now looking at business management strategies for
their practice, career change, and business focus for
their practice should read Michael Gerber’s book, The E-Myth: Physician. Believe me, choices such
as this are part of your medical business and
marketing plans whether you know it or not.

(I am receiving no
compensation for this article from any entity
whatsoever.
I have no agreements, contracts, special
arrangements with
any individual
or organization
having to do with any aspect of concierge medical
practice anywhere. My intention is to make physicians
aware of possible medical practice methods that they
may choose to establish for
their
financial
stability.)

Article #12A

ARTICLE---DAN
KENNEDY

Why People Fail

A series of No B.S. articles from
Dan Kennedy

"Watch The News.
Make News."

I happen to be a politics junkie and,
therefore, a news junkie. I even write
political columns, so I have to pay
attention daily. But I learned years
ago
that it is the news media’s job to
make every problem a crisis, every
item of earth-shaking, life-altering
importance. Few news events actually
are. As a matter of fact, most things
wind up being about as important as
you permit
them to be.

Few people think of themselves as
news-makers.

All the world’s a stage, and on it
there are players, but there are
countless more spectators. It never
dawns on people how much of their time
is spent as a spectator, how little
spent actually playing a game over
which they exercise control. Millions
watch football on any given Sunday.

Only a small cadre of coaches scheme
to win their games on Sunday, a small
number of players work hard all week
to be mentally and physically prepared
to win the games in which they
compete. It’s significant that the
spectators rarely make news – the
winning players and coaches do. And
the spectators never get million
dollar contracts to watch. They must
pay for that privilege.

There is that old cliché, about three
kinds of people: those who make things
happen; those who watch things happen;
those who wonder what the heck
happened, why, and why they were left
out! There’s a lot of truth to the
cliché. Most people act as if they are
in a little boat set adrift in a vast
ocean of circumstances beyond their
control, rowing fast and frantically,
looking about endlessly for someone to
come to their rescue. Few are
captains.

It’s my observation that exceptionally
successful people are very
deliberative and purposeful about
three things, in this regard. First,
they act as captains. Every day – yes,
every day – they set out on a
charted course of their choosing; they
never meander about aimlessly.

Two, they are “makers”, creators,
doers. They make things happen, make
things move forward, get things done,
sometimes through sheer force of will
and refusal to accept or excuse less.
In doing so, they are even, from time
to time, news-makers, to their
clientele, in their industry, in their
community.

Third, they seek association with
people of this ilk, and abbreviate as
best they can the time spent with or
on people not so self-determining,
self-motivating. They recognize just
how powerful association is.

My friend, the late Jim Rohn said that
given the bank balances of the five
people you hang out with the most, he
could “guess” your bank balance with
great accuracy. He also noted that
rich people have big libraries, poor
people prefer big TV’s – a way of
asking you what sort of ideas you
associate with most. A lot of people
with 52” plasma’s and TV’s in three or
four rooms of the house say they have
no time to read.

Most accomplishment or lack thereof is
result of investment – not
accident. Those who are endlessly,
constantly disappointed with their
incomes, businesses, lives, prefer
believing in accident, luck,
randomness as a comforting religion,
but that’s delusional.

Examination of
most success reveals controllable
causes, notably that person’s
investments of his time, energy,
money, in association with productive
and provocative ideas, and people who
are in the game, not in the bleachers.

The WHY PEOPLE FAIL articles are provided by Dan S. Kennedy,
serial entrepreneur, from-scratch
multi-millionaire, speaker, consultant, coach, author of
over 13 books including the No B.S.
series (
www.NoBSBooks.com), and editor of The No B.S. Marketing Letter.
WE HAVE ARRANGED
A SPECIAL FREE GIFT FROM DAN FOR YOU including a 2-Month Free Membership in Glazer-Kennedy
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